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Depressed after two weeks: fears drug companies will target the grieving

The grieving process is in danger of being branded a medical condition if a mourner feels sad for two weeks and consults a GP, according to an international authority on death and dying.

At present, mourners must be feeling sad for two months before potentially being told they have a mental disorder, says Professor Dale Larson. Decades ago, a diagnosis could be made after a year.

Mental illness is being redesigned. The Diagnostic and Statistical Manual of Mental Disorders (DSM) will be updated this year, meaning what counts as a psychiatric disorder will change.

In a keynote address at an Australian Psychological Society conference in Melbourne on Saturday, Prof Larson will express his anger at the new guidelines.

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First published in 1952, the manual was initially a 130-page collection of disorders, often listed with no symptoms and heavily influenced by Freudian, psychodynamic theories.

It wasn't until its third revision, in 1980, that it really took off. Credited with saving the psychiatric profession from vague diagnoses that often varied wildly from doctor to doctor, hospital to hospital, and country to country, it added much-needed reliability to the profession.

Today, it runs to nearly 900 pages and it is estimated it could earn its owner, the American Psychiatric Association, $US100 million.

Seemingly small changes to the DSM, often referred to as the psychiatrists' bible, can have a massive impact on patients the world over, because access to treatment depends on its definitions.

Drug companies rely on the DSM too: if criteria for a disorder are loosened, vastly more people become candidates for medication.

The new version of the manual, to be published in May, allows a diagnosis of depression after two weeks of grieving.

According to Prof Larson, the manual undermines the legitimate feelings of the mourner and the help available from family, support groups, clerics and professional counsellors.

"We are essentially labelling grief a disorder. Now it becomes a target for drug development."

Nearly 70 per cent of the DSM-5 taskforce have declared they have ties to the pharmaceutical industry.

Allen Frances, one of the architects of DSM-4, says the changes being proposed by the DSM-5 taskforce will see people throughout the world waking up with a mental disorder.

When his taskforce reduced the number of symptoms needed to qualify a person as having ADHD, they thought the prevalence of the disorder might increase by 15 per cent among children.

Instead, it increased by 200 per cent. At the same time, autism diagnoses increased by 2000 per cent.

Now Prof Larson, head of Counselling Psychology at Santa Clara University in the US, is concerned GPs will be dishing out prescriptions for anti-depressants.

"Almost all bereaved people believe they are depressed. But grief is a normal healing process and it resolves itself in most cases.

"Bereavement-related depression is different from other kinds of depression," he told AAP on Friday.

"Medication, not psychotherapy, will be the major treatment because most people see their GP when they have an issue."

In Australia, about 85 per cent of prescriptions for psychiatric drugs are written by GPs, and less than 10 per cent by psychiatrists.

There were over 22 million government-subsidised prescriptions for mental health-related medications in 2009, accounting for 11 per cent of all subsidised prescriptions.

Between 2005 and 2010 the average rate of psychiatric drugs prescribed in the community increased by about 2 per cent each year, national prescribing figures show.

Prof Larson acknowledged support in Australia might be more focused on the needs of the mourner, who could take advantage of a Medicare benefit and consult a psychologist.

He said the focus should be on "helping the mourner figure out grief's questions: 'What's happening to me and how long will it last?'

"It's a bonanza for the pharmaceutical industry. The GP prescribes anti-depressants and the bereaved feel better, largely because of placebo effects. The truth is people are resilient and they would have got better on their own.

"If they do struggle, and many do, talk therapy should be the first line of support."

Prof Larson said the authors of the new guidelines had a genuine desire to help people. "People do have complicated grief. That's a reality. One option would be to include a diagnosis for prolonged grief disorder.

"I personally think a year is the minimum amount of time before a disorder should be diagnosed, if we do medicalise this universal human experience."

AAP and Amy Corderoy

24 comments

People grieve, that's what happens when you loose a member of your family or your friend.

I have friends that were particularly traumatised by the death of a friend/family member (witnessing their friends murder & loosing their mum to a very brief but horrific cancer battle) that both went to psychologists and it made so much difference to them.

I do not agree that drugs should be issued because that does nothing to address the problem, just mask. The role of psychologists, therapists and counselling can make such a drastic improvement in the lives of people affected adversely by death, and I believe the government should support this 100%.

Commenter

Ellie

Date and time

February 22, 2013, 12:19PM

Certainly medications aren't a complete solution, but they can be helpful. Some of my clients wouldn't be able to engage with therapy if they weren't on medication (such as anti-depressants), because otherwise their symptoms are so severe that they can't function on a day-to-day basis. Medications don't always just "mask" a problem, they can act as a safety net that helps a patient survive and cope while they engage with psychological treatment.

NB: Before someone jumps on my back about pushing drugs on clients, please note that psychologists do not and cannot prescribe medication, though we often work with GPs or psychiatrists who do.

Commenter

Psychologist

Date and time

February 22, 2013, 3:07PM

I spent 12 months after my mother's death in a deep depression - I somehow functioned during working hours and slipped into nowhere land after that. Society at large seems to think that "you need to move on" - there is no help or recognition of the need for help. You might not have access to prescription drugs but there are lots of drugs at Dan's that help you into oblivion. 2.5 years later I am doing a bit better but not a lot.

Commenter

On the Edge

Date and time

February 22, 2013, 3:31PM

@psychologist

I agree that there are some clients who benefit from medication in conjunction with psychotherapy, but in my experience many clients find medication hasn't helped them as well. In addition, they have side-effects which many people find difficult to tolerate, and when deciding to come off anti-depressants, it must be done very carefully as withdrawal symptoms can be extremely severe and debilitating. Many people don't realise this. Also,I have found that a number of people have remained on anti-depressants for years without having had any appropriate psychotherapy. It can become like an addiction, which isn't helpful.

But, I think the issue being pointed out by the article and Ellie is that people who would otherwise be within the normal range of the grieving process will be diagnosed as mentally ill and inappropriately medicated. This is exactly what pharmaceutical companies want. I know this because a friend of mine used to work as a salesperson for one of them and she explained it in detail. Pharmaceutical companies push for a broadening of the boundaries of illness, physical and psychological, for which medication can be prescribed, especially pushing for chronic use. All sorts of methods are employed to try to being this about, including having connections with the board working on DSM, and using various incentives for medical and allied health professionals. It's outrageously unethical, and the new DSM ought to be thrown out and replaced with ICD in protest. I think we're way overmedicating adults and children without providing the psychological services necessary. With psychological health, it takes time and money.

Commenter

Another psychologist

Date and time

February 22, 2013, 4:55PM

Your should get some other views from Professor Robert Spillane at Macquarie University: he places a truly interesting light on the DSM. As you have already mentioned, a large proportion of the architects of the 'bible' are tightly linked to pharma companies... I wonder what their agenda is? or does wondering actually mean I have a 'mental illness' and need prescription drugs to stop me wondering...? :)

Commenter

Fred

Location

Sydney

Date and time

February 22, 2013, 12:23PM

I grieve every time i see an ad for a funeral plan on TV. The endless peddling of the guilt of death should be a crime instead of something shown with monotonous regularity every six minutes on TV. I grieve openly for the sad state of Australia's mindset.

Commenter

Moo

Location

Bogan Heights

Date and time

February 22, 2013, 12:33PM

+1Couldn't have put it better meself.That's what these comments are missing - a "like" button.

Commenter

crazy eddie

Date and time

February 22, 2013, 3:16PM

absolutely insane - that so called professional experts can so grossly miscategorise human sadness and grief - such that the range of human emotion is narrowing so rapildy that we all needs legal drugs to cope. we really are getting dumber and dumber. do these idiots expect us to believe their nonsensensical labels? do they really believe them? or is it all a farce to cover their support for the legal drug trade? what a load of crap.

Commenter

pixi

Location

mars

Date and time

February 22, 2013, 12:42PM

Humans have used mood-altering drugs since prehistoric times. As long as the side effects are known and they are not too highly addictive, I see no harm. I've fortunately been spared the grief of the early loss of a loved one, but when the time comes I may well want to turn to drugs for relief. My body, my choice. Hands off with your knee-jerk moralising.

Commenter

roto

Date and time

February 22, 2013, 3:18PM

One of the big problems with current conceptualisations of mental health is the way mental health difficulties are medicalised and seen as a physical illness.

There are undoubtedly biological markers associated with mental health problems. But the direction of causation is far from clear. No single cause has ever been found for any "mental health condition".

Medication is more beneficial the more severe the problems - with treatment for psychosis the most important/essential to managing to live on a day to day basis.

However, the reality is our mental/emotional conditions are very complex. They are not static - they ebb, and flow, and change. There are many many personality and other factors which contribute to our mental health. All human experience and behaviour is on a continuum - there are no clear barriers between "healthy" and "unhealthy" - only degrees of health.

These days you can pop so many pills which supposedly target problematic chemical processes within the brain, to very mixed effects, with all sorts of side effects. Research shows that anti-depressant medication is not much more effective at treating depression than placebo pills, and even less effective for anxiety medications. Psychiatrists dont actually know how or why medications have success when they do.

People often don't realise how flexible and able to change our mental/emotional states are, without medication. Or that, by changing our psychological processes, we change our biology in accordance with them. The biggest limitation of psychological treatments over pharmaceutical ones is that they take a lot more time and effort. But for those motivated, the potential learning and rewards can be truly worth it. They may also provide the only solution, when medications don't work.